Medical tourism is far from a new phenomenon. In the 18th century, taking to the rejuvenating spa waters of Bath in Great Britain or Spa in Belgium was a popular pastime among the upper classes, but as far back as medieval times such waters attracted countless visitors, all hoping to be revitalized by their curative properties. Elsewhere in the world, hot springs like those at Kusatsu and Yamanka in Japan have been renowned for centuries for their healing powers, as have those on New Zealand’s North Island.

Fast-forward 300 years and many are making more than a well-intentioned journey to soak away their aches and pains. Faced with spiralling health insurance costs and ever-growing waiting lists for even the most straightforward of operations, many consumers in the West are taking the matter of health into their own hands.

Patients are exercising their rights as consumers and taking advantage of the lower costs of health care elsewhere in the world, where procedures are a fraction of what they would pay at home. It’s not just a handful of people making the journey either: the Bumrungrad hospital in Thailand, for example, attracts over 400,000 international visitors every year, and India has officially designated health care as an export.

With the cost of flights to anywhere in the world enticingly low, boarding a plane for a health treatment is an all-too-tempting prospect for many. What’s more, agencies specialising in international medical travel, sometimes known as health travel planners or medical concierge agencies, are a growing part of the medical travel industry and work with hospitals, airlines, hotels and recovery retreats abroad to offer patients top-notch service at affordable rates. One such organisation is South Africa-based Surgeon and Safari, which promises “privacy in paradise, with the time to heal away from public scrutiny.”

The founder of the company, Lorraine Melvill, happily forwarded client emails to Change Agent. One recent customer, Miek, proclaims, “Thank you for your care and cheerfulness. I have had two wonderful weeks to remember and an updated face in the process. My husband was very impressed. He had been convinced that I would look bruised and would want to hide for another couple of weeks, or need after-care.”
Melvill said that many clients use them more than once.

“Twenty percent of our business comes from repeat clients. If you offer any medical client a good service with attention to detail and a good level of after-care they will come back,” Melvill said.

One of the most prominent medical concierge companies in the United States is Chicago-based MedRetreat. Their website aims to put the customer at ease and contains detailed information on the procedures they offer and the destinations in which the company operates.

Managing Director Patrick Marsek says, “We’re very patient-centric. When our clients are overseas, they are assigned a Destination Programme Manager who understands American culture and will hold their hand through every step of the procedure.”
Indeed, as Josef Woodman, author of Patients Beyond Borders, points out: “Many hospitals meet patients at the airport, and supply them with in-country cellphones, transportation from their hotel, special cuisines, interpreters and the like.”

Much more than a referral service, MedRetreat takes care of every aspect of the medical tourism experience, from tracking down the right surgeon to finding suitable post-procedure accommodation. MedRetreat is so confident it can please clients that it even offers a money-back guarantee as well as a 100% refund on deposits.

“We want to help customers make that leap of faith, so they can think ‘if worse comes to the worst, I can always go back home.’” It’s an approach that’s paid off, Marsek says. “Our patients are usually so happy with the standard of treatment they received and our efforts to ensure that they are operated on by the very best surgeons that we have plenty of referrals, plus many second and third time medical tourists, particularly on the cosmetic side.”

Their most popular procedures are “face and neck lifts, rhinoplasty and liposuction,” although he reveals that more serious treatments such as hip resurfacing are becoming increasingly popular. “As medical tourism becomes more mainstream, people are realising it can be safe to have complex procedures carried out overseas.”

Because MedRetreat does not charge clients for their services - the company receives a discount from its hospital partners who also pay them for their services - Marsek explains that it does not make sense for clients to cut out the middleman and go straight to the doctors themselves.

“Why should they when we’ve travelled the world to find the best doctors and hospitals?” he asks. Surgeon and Safari’s Melvill adds, “There will always be some people who will want to go straight to the doctor and we can’t really do anything about that. But they will not get the personalised service and after-care which is what you need when you’re out of your comfort zone away from home.”

Another well-established medical concierge company is California-based Planet Hospital. President Rudy Rupak is keen to emphasise just how detail- oriented the company is when it comes to customer care. “If a patient has a nut allergy, for example, we would probably recommend that they don’t travel to Thailand, where a lot of the food is either cooked in, or contains nuts.” As for repeat clients, Rupak claims they have many, particularly for cosmetic operations. “Actually, we have to dissuade some clients from having so many procedures - the human body can only take so much,” he admits. Perhaps unsurprisingly given such a responsible attitude, customer satisfaction levels are high. “Over 97% of our feedback is positive,” adds Rupak.

Many of those who have opted for treatment overseas are evangelistic about the care they received, with some claiming they were treated like celebrities. It’s a far cry from over-stuffed waiting rooms tended by overworked, stressed-out doctors and nurses, and such a positive experience will obviously ensure that the concierge service and hospital staff form a close bond with the customer. Depending on the treatment chosen, there are different levels of customer loyalty. “Dental and cosmetic patients tend to return to same clinics and countries for ongoing care, building relationships with in-country doctors,” says Woodman. “Cardiac, orthopedic, IVF and so on tend to be one-offs, and repeat business isn’t common, unless for complications, which are rare,” he explains.

As consumers thumb glossy hospital brochures taking in images of deluxe hospital suites and smiling doctors, it’s understandable that some may feel they’re booking a holiday, not a procedure. But purchasing healthcare is obviously not the same as buying any other service, and the same market rules cannot be applied.

As Jill Quadagno, author of One Nation Uninsured: Why the U.S. Has No National Health Insurance, asserts, “The fact that there is an expert intermediary between the product (healthcare services) and the consumer (the patient) makes it difficult to apply the logic of the market.”

As some medical tourism critics note, the industry over-commercialises medicine, giving patients a sense of entitlement, and a mindset more of a consumer than a patient. But when it comes to healthcare, that old adage about the customer always being right does not – or at least should not – apply.

How, after all, can a patient possibly know what medical treatment is right for them? As Woodman points out, “Medical tourism horror stories often involve complications, which usually occur when the patient did not follow physician’s orders, or was careless in follow-up.”

Indeed, not every medical tourist has been happy with the treatment he/she received, and there are some (although not a considerable) amount of stories detailing botched operations and poor health care. Prospective patients also must consider that, if complications arise, they may have to make an inconvenient and expensive return journey – but at least some procedures such as dental work are guaranteed. If things go badly wrong, then seeking justice through the courts isn’t usually an option.
As Woodman asserts in his book, “the intricacies of working with foreign statutes, legal systems and counsel make such an action impractical.”

Despite the disadvantages, the industry continues to expand at a rapid rate. Woodman says that some health insurers in the United States now cover cross-border travel, an initiative that will only serve to develop the medical tourism industry, as well as consumer benefits in this area. “Blue Cross Blue Shield and Healthnet of California both offer this service now. Plus there’s a vast increase in the number of JCI-accredited hospitals - more than 130 - a figure that is expected to double by 2010. That’s providing huge choice for quality-conscious healthcare consumers,” Woodman adds.
As the medical concierge industry continues to grow, the focus on increasingly personalised customer service looks set to increase as concierge services battle it out for business, enticing prospective patients with extra benefits.

How do the medical concierges plan to stay on top of their game?

“By continuing to offer a reputable service that is not quantity-driven at all,” says Melvill, while Planet Hospital and MedRetreat both reveal plans to work more closely with insurance companies in the future, as well as maintaining their high levels of customer service.